Another overspend by the Isle of Man's Department of Health is of "serious concern", a member of Tynwald has said.
Jane Poole-Wilson MLC expressed her concerns as the Manx parliament unanimously approved a request for an extra £4m to plug the 2018-19 deficit.
"Without decisive and bold action to improve efficiency and effectiveness we are not securing proper value for this money," said Mrs Poole-Wilson.
Health Minister David Ashford MHK said rising spending on medicines and a pay increase for NHS staff had contributed to the current financial year's overspend.
He said his department was forecasting that "it may exceed its budget by up to £4m".
But he added that he "firmly believe[s] that our financial position is improving".
The department was allocated a budget of nearly £220m in 2018-19.
In the next financial year the Department of Health's budget will increase by £3m.
Total government spending in 2019-20 will be £1.038bn.
The overspend in 2017-18 was £9.5m.
A review of health services in the island, which is expected to make a number of recommendations, is due to be debated by Tynwald in May.
Mr Ashford said his department would then have to "grasp the nettle" by introducing reforms.